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Antihistamines Linked to Delayed Care for Severe Allergic Reaction: Study

MONDAY, Oct. 28, 2019 — Giving antihistamines to a child suffering a potentially fatal allergic reaction may do more harm than good if it causes a delay in emergency treatment, a new study warns.

Researchers reviewed the medical records of young patients, aged 8 months to 20 years, who were admitted to a pediatric intensive care unit for treatment of anaphylaxis between July 2015 and January 2019.

The investigators found that 72% of patients who took antihistamines at home delayed seeking medical care, compared to 25% who didn’t take antihistamines.

“Anyone experiencing symptoms of anaphylaxis, which can constrict airways and circulation, should seek medical care immediately and use an epinephrine auto-injector if they have been prescribed one,” said lead author Dr. Evan Wiley, a pediatric resident at Jacobi Medical Center in New York City.

But many families first turn to antihistamines and wait to see if they might ease the allergic reaction, he said. That can be a risky mistake.

The findings were to be presented Sunday at the American Academy of Pediatrics (AAP) annual meeting, in New Orleans. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

“While the use of antihistamines might help some allergic symptoms such as rash or itching, those medications will not prevent death from anaphylaxis,” Wiley said in an AAP news release. “It is important for patients with anaphylaxis to seek immediate medical care, since the only proven lifesaving treatment is epinephrine, and any delay in receiving appropriate treatment can be fatal.”

The most common trigger for anaphylaxis is food allergies, which are on the rise in children, according to the U.S. Centers for Disease Control and Prevention.

More information

The Mayo Clinic has more on symptoms and causes of anaphylaxis.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Planting and Taking Care of Cannabis Seeds – A Short Guide

We all love cannabis, right?

Most of us who live in legal areas smoke marijuana regularly. But how many of us have ever wondered about how these sweet, heart-melting green fluffs of heaven are made?

It is quite easy to take the marijuana bud, crush it, grind it, and smoke it. But if you go behind the scenes and try to find out how much goes into growing a healthy cannabis plant, you will be surprised.

Don’t worry!

We aren’t here to write long paragraphs and bore you!

We are just going to tell you a little about how to grow marijuana yourself at home. It’s not rocket science, but you should have basic knowledge before you jump into it and start the journey yourself.

So where should you start?

First!

You need marijuana seeds. Getting high-quality seeds is easy if you know where to look. Make sure you don’t buy seeds from dodgy people around your neighborhood.

There are so many different marijuana seed banks that ship to the USA. Just order whichever strain you like from them, and they will make sure it gets delivered safely to your doorstep.

Easy, yeah?

So now that you have cannabis seeds, you will need to germinate them. Generally, the germination process can take two days for marijuana seeds.

But how would you know that the seed is germinating?

Basically, you notice that small sprouting happens through your cannabis seeds. Once these sproutings are between ½ and ¾ inch in size, you can consider it as germination phase end.

The newborn sprout should be white in color. Make sure you handle it with care and transfer it into a growing medium.

You find growing mediums online if you want or you can use a mixture of sterile soil and compost. Another great sprouting medium is a rooting cube. These are usually made out Rockwool and are great as they hold both water and air inside it.

Still with us? Don’t worry! It will be worth it. READ ON.

Keep this medium moist at all times as your cannabis seed loves a moist environment.

Now it will time to plant these seeds inside the soil. Make sure that the soil is fluffy and airy. We don’t want a huge rock-solid lump of soil.

Without touching the sprouts with bare hands, take them, and gently put them in the soil. You can use sterilized tweezers to do the transferring.

Make sure you don’t keep the germinated seed in the open air for too long, do this step quickly and carefully.

Pre-digging smalls holes in your soil will help you place the seeds directly into it.

Pretty easy stuff, huh?

Cover these seeds with a layer of soil no more than ¼ inch. Anything more and the sprout may struggle to come out the soil. We need a very bare minimum layer of soil on the seed.

Now you need to wait and keep an eye on the soil. It should not get dry, keep spraying water very lightly and keep it moist.

This is the delicate part!

Shortage of moisture will make the seed die, and too much of moisture will drown it. Make sure it all in balance.

Light watering once or twice a day is generally enough, but this will change depending upon your environmental conditions.

The small marijuana seedlings don’t like sunlight, so make sure you don’t give them direct sunlight. Although, you can place them in a cool light and warm atmosphere.

When the seedlings start to grow and change into a small plant, we would call it vegetation plant phase.

In the vegetation phase, you would need specific lighting conditions, nutrition input, and environment. We would not bore you will all the details right now, but after the vegetation stage, you plant will beout of danger zone.

A little bit of caring will make the plant grow vigorously and go into flowering stages and give you those awesome cannabis buds at the end.

See, didn’t we tell you? It’s not rocket science! XD

Shane Dwyer
Author: Shane Dwyer
Shane Dwyer is a cannabis advocate who isn’t afraid to tell the world about it! You can find his views, rants, and tips published regularly at The 420 Times.

Marijuana & Cannabis News – The 420 Times

Groupons For Medical Treatment? Welcome To Today’s U.S. Health Care

By Lauren Weber

Friday, September 06, 2019 (Kaiser News) — Emory University medical fellow Dr. Nicole Herbst was shocked when she saw three patients who came in with abnormal results from chest CT scans they had bought on Groupon.

Yes, Groupon — the online coupon mecca that also sells discounted fitness classes and foosball tables.  

Similar deals have shown up for various lung, heart and full-body scans across Atlanta, as well as in Oklahoma and California. Groupon also offers discount coupons for expectant parents looking for ultrasounds, sold as “fetal memories.”

The concept of patients using Groupons to get discounted medical care elicited the typical stages of Twitter grief: anger, bargaining and acceptance that this is the medical system today in the United States.

But, ultimately, the use of Groupon and other pricing tools is symptomatic of a health care market where patients desperately want a deal — or at least tools that better nail down their costs before they get care.

“Whether or not a person may philosophically agree that medicine is a business, it is a market,” said Steven Howard, who runs Saint Louis University’s health administration program.

[khn_slabs slabs=”790331″ view=”inline” /]

By offering an upfront cost on a coupon site like Groupon, Howard argued, medical companies are meeting people where they are. It helps drive prices down, he said, all while marketing the medical businesses.

For Paul Ketchel, CEO and founder of MDsave, a site that contracts with providers to offer discount-priced vouchers on bundled medical treatments and services, the use of medical Groupons and his own company’s success speak to the brokenness of the U.S. health care system.

MDsave offers deals at over 250 hospitals across the country, selling vouchers for anything from MRIs to back surgery. It has experienced rapid growth and expansion in the several years since its launch. Ketchel attributes that growth to the general lack of price transparency in the U.S. health care industry amid rising costs to consumers.

“All we are really doing is applying the e-commerce concepts and engineering concepts that have been applied to other industries to health care,” he argued. “We are like transacting with Expedia or Kayak while the rest of the health care industry is working with an old-school travel agent.”

Continued

A Closer Look At The Deal

Crown Valley Imaging in Mission Viejo, Calif., has been selling Groupon deals for services including heart scans and full-body CT scans since February 2017 — despite what Crown Valley’s president, Sami Beydoun, called Groupon’s aggressive financial practices. According to him, Groupon dictates the price for its deals based on the competition in the area — and then takes a substantial cut.

“They take about half. It’s kind of brutal. It’s a tough place to market,” he said. “But the way I look at it is you’re getting decent marketing.”

Groupon-type deals for health care aren’t new. They were more popular in 2011, 2012 and 2013, when Groupon and its then-competitor LivingSocial were at their heights. The industry has since lost some steam. Groupon stock and valuation have tumbled in recent years, even after buying LivingSocial in 2016.

Groupon did not respond to requests for comment on how many medical offerings it has featured or its pricing structure.

“Groupon is pleased any time we can save customers time and money on elective services that are important to their daily lives,” spokesman Nicholas Halliwell wrote in an emailed statement. “Our marketplace of local services brings affordable dental, chiropractic and eye care, among other procedures and treatments, to our more than 46 million customers daily and helps thousands of medical professional[s] advertise and grow their practices.”

Lauren Weber discussed using Groupons for medical treatment on KCBS Radio on Sept. 9.

Can’t see the audio player? Click here to download.

In Atlanta, two imaging centers that each offered discount coupons from Groupon said the deals have driven in new business. Bobbi Henderson, the office manager for Virtual Imaging Inc.’s Perimeter Center, said the group had been running the deal for a heart CT scan, complete with consultation, since 2012. Currently listed at $ 26 — a 96% discount — more than 5,000 of the company’s coupons have been sold, according to the Groupon site.

Continued

Brittany Swanson, who works in the front office at OutPatient Imaging in the Buckhead neighborhood of Atlanta, said she has seen hundreds of customers come through after the center posted Groupons for mammograms, body scans and other screenings around six months ago.

Why did the company choose to make such discounts available?

“Honestly, we saw the other competition had it,” she said.

A lot of the deals offered are for preventive scans, Swanson said, providing patients incentives to come in.

But Dr. Andrew Bierhals, a radiology safety expert at Washington University in St. Louis’ Mallinckrodt Institute of Radiology, warned that such deals may be leading patients to get unnecessary initial scans — which can lead to unnecessary tests and radiation.

“If you’re going to have any type of medical testing done, I would make sure you discuss with your primary care provider or practitioner,” he cautioned.

Appealing To Those Who Fall Into The Insurance Gap

Because mammograms are typically covered by insurance, Swanson said she believes OutPatient Imaging’s $ 99 Groupon deal is filling a gap for women lacking insurance. The cost of such breast screenings for those who don’t have insurance varies widely but can be up to several hundreds of dollars without a discount.

Groupon has long been used to fill insurance gaps for dental care, Howard said. He himself often bought such deals over the years to get cheaper teeth cleanings when he didn’t have dental insurance.

But advanced medical scans involve a higher level of scrutiny, as Chicagoan Anna Beck learned. In 2015, she and her husband, Miguel Centeno, were told he needed to get a chest CT after a less advanced X-ray at an urgent care center showed something suspicious. Since her husband had just been laid off and did not have insurance, they shopped online for the cheapest price. They ended up driving out to the suburbs to get a CT scan at an imaging center there.

“I knew that CT scans had such a wide range of costs in a hospital setting,” Beck said. “So going in knowing that I could price-check and have some idea of how much I’d be paying and a little more control” was preferable to going to the hospital.

Continued

On the drive back into the city, the center called and told them to go straight to the hospital — the scan had discovered a large mass that turned out to be a germ-cell tumor.

Fortunately, Centeno’s cancer is now in remission, Beck said. But their online shopping cost them more money than if they’d gone straight to the hospital initially. The hospital gave them charity care. And although Beck took along a CD of the scans Centeno had found online, the hospital ended up taking its own scans, as well.

“You’re trying to cut cost by getting a CT out of the hospital,” she said. “But they’re just going to redo it anyway.”

WebMD News from Kaiser Health News

©2013-2018 Henry J. Kaiser Family Foundation. All rights reserved.

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Administration Ends Migrant Medical Care Protection

Aug. 27, 2019 — An exemption that allows immigrants to remain in the United States and avoid deportation while they or family members receive life-saving care has been scrapped by the Trump administration.

The policy change was effective Aug. 7, according to a Citizenship and Immigration Services spokeswoman, and letters were issued to affected people, the Associated Press reported.

The decision could force migrants to seek less effective treatment in their homelands, critics say.

“This is a new low,” Democratic Sen. Ed Markey said. “Donald Trump is literally deporting kids with cancer.”

Honduras native Mariela Sanchez arrived in the U.S. with her family in 2016 and recently applied for the exemption for her 16-year-old son, Jonathan, who has cystic fibrosis, the AP reported.

A denial would amount to a death sentence for her son, said Sanchez, whose family settled in Boston.

“He would be dead,’ if the family had remained in Honduras, she told the AP. “I have panic attacks over this every day.”

In Boston alone, the Trump administration decision could affect about 20 families with children being treated for cancer, HIV, cerebral palsy, muscular dystrophy, epilepsy and other serious conditions, according to Anthony Marino, head of immigration legal services at the Irish International Immigrant Center, which represents the families.

“Can anyone imagine the government ordering you to disconnect your child from life-saving care — to pull them from a hospital bed — knowing that it will cost them their lives?” Marino told the AP.

The letters sent to applicants for the exemption order them to leave the country within 33 days or face deportation, which could harm their future visa or immigration requests.

WebMD News from HealthDay

Copyright © 2013-2018 HealthDay. All rights reserved.

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WebMD Health

Many Doctors Refusing Care of People Prescribed Opioids

THURSDAY, Aug. 15, 2019 — Folks taking opioids for chronic pain may run into trouble if they need to find a new doctor.

A new “secret shopper” survey of 194 Michigan primary care clinics found that as many as four out of 10 primary care doctors would turn away patients who have been taking the pain-killing medications (such as Percocet) long term. And that’s true even if those physician practices said they are open to taking new patients.

“This is a prevalent problem — more so than we expected,” said study author Dr. Pooja Lagisetty, from the University of Michigan Medical School and the VA Ann Arbor Healthcare System.

For the study, researchers called physician practices, posing as a potential new patient. The “patients” explained that they were taking opioids for chronic pain and said they had either Medicaid or private health insurance.

Lagisetty said she hopes the study gets health care systems thinking about this problem.

“I hope it gets physicians thinking, ‘What can we do better?’ By closing doors on patients, we’re not helping anybody,” she said. “We need to dig into this problem to find out what’s driving it.”

Lagisetty said there are probably multiple reasons that doctors turn certain patients away.

“Stigma is probably a component, and another big component is probably the administrative burden that comes with prescribing opioids. It’s not a trivial amount of work to manage someone on opioids safely. I suspect some clinics may be a little overburdened,” she said.

Dr. Noel Deep, a spokesman for the American College of Physicians, suspects the problem is less about stigma and more about the regulatory burden related to prescribing opioids.

“Physicians have to think twice when prescribing opioids, and if you’re in a small, rural practice, it gets difficult. Physicians can also be targeted for overprescribing,” he said.

Dr. Yili Huang, director of the pain management center at Northwell Phelps Hospital in Sleepy Hollow, N.Y., agreed that opioid regulations might make physicians hesitant to take on a patient who’s using them, even if that patient doesn’t have an issue with addiction.

While people taking opioids are at a very high risk of misuse or abuse, Huang said about three-quarters of people who take them don’t misuse them and about 90% don’t develop an addiction. He did note, however, that many people can have their pain successfully managed without opioids.

But for those who do need them, the increased scrutiny and potential risk to a doctor’s license and livelihood may keep them from taking on these patients.

So, what can happen if people treating chronic pain with opioids can’t find a doctor?

Lagisetty said patients could be left with uncontrolled pain, and may have withdrawal symptoms. If they attempt to see several doctors for opioids, they may be labeled as a “drug-seeker” and have difficulty accessing their pain medications.

For those who are abusing the opioids, in some states they won’t have access to the medication that can reverse an overdose. They also won’t get a referral for addiction treatment.

Deep said, “Patients have to come first. If patients can’t get medications, there can be very bad outcomes.” He noted that patients might end up driving long distances to seek pain relief. Some might even use illicit drugs.

All three experts said there’s a need for increased addiction education, as well as some flexibility in prescribing guidelines.

The news from the study wasn’t all bad, Lagisetty pointed out. While around 40% of doctors turned chronic opioid users away, 60% were willing to see them.

Huang added, “Despite increasing regulatory scrutiny, many providers continue to care for patients on chronic opioids.”

The study found no difference in whether doctors would see patients based on the type of insurance they had.

“This suggests that there may not be any financial or discriminatory incentive behind these actions, and instead [turning these patients away] is driven solely by fear of policy repercussions and lack of education,” Huang explained.

The study was recently published online in JAMA Network Open.

More information

Learn more about pain treatment options from the U.S. National Institute on Aging.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

Drugs.com – Daily MedNews

10 Anti-Aging Hair Care Tips

photo of mature woman outside

Your hair, like your taste in music and comfort level with social media, can give away your age. Hair changes with age just like the rest of your body. “Hair follicles get smaller, sebum production declines, and some people lose pigment cells and go gray,” says Francesca Fusco, MD, assistant clinical professor of dermatology at Icahn School of Medicine at Mount Sinai in New York City.

As hormones change, the hair sheds more and grows back more slowly, causing it to thin, says David Kingsley, PhD, president of the World Trichology Society. In addition, hormones trigger a reduction in sebum production that can leave the hair feeling dryer. At the same time, pigment cells in the hair bulb wane over time, Fusco says, so hair turns gray.

But while your hair changes with age, you can update it. We asked the experts to share their best anti-aging hair care tips and tricks to keep your strands looking healthy and youthful to represent your individual style.

See Your Doctor

“Address any thinning early,” Fusco says. “We have treatments like minoxidil and Propecia that work to regrow hair,” she says. “But it’s best to rule out other causes like anemia, iron deficiency, autoimmune disorder, or the side effects of medication.”

Get the Right Cut

“As your hair thins, it’s not a bad idea to cut your hair a bit shorter, but it’s a myth that you have to cut your hair short once you reach a certain age,” says Nunzio Saviano, owner of Nunzio Saviano Salon in New York City. “You can have beautiful hair that’s below your shoulders as long as it’s cut in longer layers that move together and give the illusion of fullness.” He explains that having too many layers only emphasizes thinning texture, but longer layers hold shape and look full.

Delve Into Your Diet

Protein and iron are the two most important things to have in your diet for healthy hair,” Fusco says. “If your diet is restricted, it can affect hair loss.” She advises asking your doctor about a blood test and a medical history to check for a deficiency in iron, vitamin D, or other minerals. Once that’s ruled out, Fusco likes the supplement Nutrafol because it contains zinc and other antioxidants that promote hair growth. “There is good research, and my patients have been happy with the results,” she says.

Continued

When in Doubt, Moisturize

Saviano tells his clients to avoid drying mousses and gels because they can cause hair to look dull and strip away shine. His trick: “I like to use mousse designed for curly hair because it tends to be moisturizing and less drying for the hair,” he says. Fusco recommends rich conditioning treatments to hydrate aging strands. She likes macadamia nut oil masks once a week.

Brush With Greatness

There’s an old wives’ tale that you should brush 100 strokes a day. That isn’t necessary, Saviano says. But gentle brushing can encourage healthy blood flow to the scalp, which is good for the hair. In fact, some research shows that scalp massage may help increase hair thickness. He suggests using a Mason Pearson soft boar bristle brush because the natural bristles are gentle on delicate strands and will distribute the hair’s natural conditioning oils.

Check the Label of Your Lather

“Look for a zinc pyrithione shampoo — it’s usually in dandruff formulas,” Fusco says. She says the ingredient is hydrating and soothing, whether you have dandruff or not, and can help anyone feeling tightness or itchiness due to decreased sebum production on the scalp.

Keep Your Cool

Heat styling can be especially damaging to thinning hair fibers. The stress can cause breakage, and since the hair is producing less sebum, you have less natural protection against the heat. Fusco warns against using too many heat tools and recommends keeping any time you expose hair to flat irons or blow dryers to a minimum.

Stay Away From Spray

Jet Rhys, owner of Jet Rhys Salon in Solana Beach, CA, tells her clients not to use too much hair spray. The drying alcohols in these stylers can cause hair to become dry and brittle.

Build Body

“There is a wonderful product called Toppik that uses vegetable fibers to camouflage areas of thinning hair,” says Mona Gohara, MD, an associate clinical professor of dermatology at Yale University. She says it’s very helpful in creating the appearance of hair thickness.

Gloss Over Gray

Gray hair naturally has a wiry, dull texture that reflects less light, Rhys says.

“Semi-permanent or permanent color can improve the texture and add body, but you don’t have to completely cover your gray,” she says. “You can just add a few ribbons to add some shine.” She also says that color has the perk of increasing volume, so it helps thinning hair feel fuller as well. “A few highlights around the temple can make a big difference in creating the look of volume and shine,” Saviano says.

Find more articles, browse back issues, and read the current issue of WebMD Magazine.

WebMD Magazine – Feature Reviewed by Mohiba Tareen, MD on March 26, 2019

Sources

SOURCES:

Francesca Fusco, MD, assistant clinical professor of dermatology, Icahn School of Medicine at Mount Sinai, New York City.

David Kingsley, PhD, president, World Trichology Society.

Nunzio Saviano, owner, Nunzio Saviano Salon, New York City.

Mona Gohara, MD, associate clinical professor of dermatology, Yale University.

Jet Rhys, owner, Jet Rhys Salon, Solana Beach, CA.

Harvard Health Letter: “Treating female pattern hair loss.”

Journal of Drugs in Dermatology: “A Six-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Safety and Efficacy of a Nutraceutical Supplement for Promoting Hair Growth in Women with Self-Perceived Thinning Hair.”

Eplasty: “Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue.”

© 2019 WebMD, LLC. All rights reserved.

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Trump Seeks Health Care Cost Details For Consumers

Anyone who has tried to “shop” for hospital services knows one thing: It’s hard to get prices.

President Donald Trump on Monday signed an executive order he said would make it easier.

The order directs agencies to draw up rules requiring hospitals and insurers to make public more information on the negotiated prices they hammer out in contract negotiations. Also, hospitals and insurers would have to give estimates to patients on out-of-pocket costs before they go in for nonemergency medical care.

The move, which officials said will help address skyrocketing health care costs, comes amid other efforts by the administration to elicit more price transparency for medical care and initiatives by Congress to limit so-called surprise bills. These are the often-expensive bills consumers get when they unwittingly receive care that is not covered by their insurers.

“This will put American patients in control and address fundamental drivers of health care costs in a way no president has done before,” said Health and Human Services Secretary Alex Azar during a press briefing on Monday.

The proposal is likely to run into opposition from some hospitals and insurers who say disclosing negotiated rates could instead drive up costs.

Just how useful the effort will prove for consumers is unclear.

Much depends on how the administration writes the rules governing what information must be provided, such as whether it will include hospital-specific prices, regional averages or other measures. While the administration calls for a “consumer-friendly” format, it’s not clear how such a massive amount of data — potentially negotiated price information from thousands of hospitals and insurers for tens of thousands of services — will be presented to consumers.

“It’s well intended, but may grossly overestimate the ability of the average patient to decipher this information overload,” said Dan Ward, a vice president at Waystar, a health care payments service.

So, does this new development advance efforts to better arm consumers with pricing information? Some key point to consider:

Q: What does the order do?

It may expand on price information consumers receive.

Continued

The order directs agencies to develop rules to require hospitals and insurers to provide information “based on negotiated rates” to the public.

Currently, such rates are hard to get, even for patients, until after medical care is provided. That’s when insured patients get an “explanation of benefits (EOBs),” which shows how much the hospital charged, how much of a discount their insurer received and the amount a patient may owe.

In addition to consumers being unable to get price information upfront in many cases, hospital list prices and negotiated discount rates vary widely by hospital and insurer, even in a region. Uninsured patients often are charged the full amounts.

“People are sick and tired of hospitals playing these games with prices,” said George Nation, a business professor at Lehigh University who studies hospital contract law. “That’s what’s driving all of this.”

Some insurers and hospitals do provide online tools or apps that can help individual patients estimate out-of-pocket costs for a service or procedure ahead of time, but research shows few patients use such tools. Also, many medical services are needed without much notice — think of a heart attack or a broken leg — so shopping simply isn’t possible.

Administration officials say they want patients to have access to more information, including “advance EOBs” outlining anticipated costs before patients get nonemergency medical care. In theory, that would allow consumers to shop around for lower cost care.

Q: Isn’t this information already available?

Not exactly. In January, new rules took effect under the Affordable Care Act that require hospitals to post online their “list prices,” which hospitals set themselves and have little relation to actual costs or what insurers actually pay.

What resulted are often confusing spreadsheets that contain thousands of a la carte charges — ranging from the price of medicines and sutures to room costs, among other things — that patients have to piece together if they can to estimate their total bill. Also, those list charges don’t reflect the discounted rates insurers have negotiated, so they are of little use to insured patients who might want to compare prices hospital to hospital.

Continued

The information that would result from Trump’s executive order would provide more detail based on negotiated, discounted rates.

A senior administration official at the press briefing said details about whether the rates would be aggregated or relate to individual hospitals would be spelled out only when the administration puts forward proposed rules to implement the order later this year. It also is unclear how the administration would enforce the rules.

Another limitation: The order applies only to hospitals and the medical staff they employ. Many hospitals, however, are staffed by doctors who are not directly employed, or laboratories that are also separate. That means negotiated prices for services provided by such laboratories or physicians would not have to be disclosed.

Q: How could consumers use this information?

In theory, consumers could get information allowing them to compare prices for, say, a hip replacement or knee surgery in advance.

But that could prove difficult if the rates were not fairly hospital-specific, or if they were not lumped in with all the care needed for a specific procedure or surgery.

“They could take the top 20 common procedures the hospital does, for example, and put negotiated prices on them,” said Nation at Lehigh. “It makes sense to do an average for that particular hospital, so I can see how much it’s going to cost to have my knee replaced at St. Joe’s versus St. Anne’s.”

Having advance notice of out-of-pocket costs could also help patients who have high-deductible plans.

“Patients are increasingly subject to insurance deductibles and other forms of substantial cost sharing. For a subset of so-called shoppable services, patients would benefit from price estimates in advance that allow them to compare options and plan financially for their care,” said John Rother, president and CEO at the advocacy group National Coalition on Health Care.

Q: Will this push consumers to shop for health care?

The short answer is maybe. Right now, it’s difficult, even with some of the tools available, said Lovisa Gustafsson, assistant vice president at the Commonwealth Fund, which has looked at whether patients use existing tools or the list price information hospitals must post online.

Continued

“The evidence to date shows patients aren’t necessarily the best shoppers, but we haven’t given them the best tools to be shoppers,” she said.

Posting negotiated rates might be a step forward, she said, but only if it is easily understandable.

It’s possible that insurers, physician offices, consumer groups or online businesses may find ways to help direct patients to the most cost-effective locations for surgeries, tests or other procedures based on the information.

“Institutions like Consumer Reports or Consumer Checkbook could do some kind of high-level comparison between facilities or doctors, giving some general information that might be useful for consumers,” said Tim Jost, a professor emeritus at the Washington and Lee University School of Law.

But some hospitals and insurers maintain that disclosing specific rates could backfire.

Hospitals charging lower rates, for example, might raise them if they see competitors are getting higher reimbursement from insurers, they say. Insurers say they might be hampered in their ability to negotiate if rivals all know what they each pay.

“We also agree that patients should have accurate, real-time information about costs so they can make the best, most informed decisions about their care,” said a statement from lobbying group America’s Health Insurance Plans. “But publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers.”

Julie Appleby: [email protected], @Julie_Appleby

WebMD News from Kaiser Health News

©2013-2018 Henry J. Kaiser Family Foundation. All rights reserved.

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Could You Afford Home Health Care? Maybe Not

By Dennis Thompson

HealthDay Reporter

THURSDAY, June 6, 2019 (HealthDay News) — The seniors most likely to need paid home care to maintain independent living are the least likely to be able to afford it long-term, a new study reports.

Only two out of five older adults with significant disabilities have the assets on hand to pay for at least a couple of years of extensive in-home care, researchers found.

Without some help, those elderly are much more likely to wind up in a nursing home, said lead researcher Richard Johnson. He is a senior fellow with the Urban Institute’s Income and Benefits Policy Center, in Washington, D.C.

“We have this perception that the risk of becoming frail is evenly distributed across the population, but it’s really not,” Johnson said. “It is more concentrated among people with less education, lower lifetime earnings and less wealth.”

Aging folks increasingly want to stay out of nursing homes as their health declines, maintaining their independence by living in their own houses, Johnson said.

But there hasn’t been a large increase in the number who are shelling out for paid home care, national statistics show.

To see why that might be, Johnson and his colleagues turned to data gathered by the University of Michigan’s Institute for Social Research.

The researchers broke paid home care down into three scenarios: limited care of 25 hours each month costing $ 475; moderate care of 90 hours a month costing $ 1,170; and extensive care of 250 hours per month costing $ 4,750 per month.

Initial results looked promising.

The investigators found that 74% of all seniors aged 65 and older could afford at least two years of moderate home care if they cashed in all their assets, and 58% could afford two years of extensive home care.

Then the researchers turned their attention to people most likely to need home care — those suffering from severe dementia or who require help with two or more activities of daily living. These activities can include eating, bathing, dressing, using the toilet, getting out of a chair or walking across a room, Johnson said.

Continued

Only 57% of those most frail seniors could afford two years of moderate home care, and only 40% could afford extensive home care for two years, the findings showed.

For these people, the burden will fall hardest on their family at first, Johnson said.

“Most people who become frail at older ages rely on unpaid family caregivers,” he said. “Those are the people who provide the vast majority of care.”

Paid home care provides relief for family caregivers, giving them a “respite from the grind of constantly being on call to help a frail loved one,” Johnson said.

Without that respite, family caregivers are more likely to wear down. That makes it even more likely that an elderly person who suffers a setback will wind up in a nursing home, Johnson said.

The findings are “disturbing,” said Eliot Fishman, senior director of health policy at Families USA, a consumer health care advocacy group. “But it’s not surprising to me,” he added.

“It’s an issue I worry gets lost in the health care reform discussion, because there tends to be a huge and understandable focus on health insurance and the affordability of health care,” Fishman said.

At the moment, paid home care tends to be expensive — an average $ 22 an hour — and isn’t typically covered by insurance, the study authors said in background notes.

Only 11% of seniors aged 65 and older have long-term care insurance, and Medicare doesn’t cover home care services, the researchers noted. Medicaid does cover home care, but there’s a waiting list and people have to be financially wiped out to qualify.

There’s also a looming shortage of home care workers, which the Trump administration’s immigration crackdown could make even worse, according to a Harvard Medical School study published this week in Health Affairs.

Immigrants account for one in every four people working in long-term care and direct care, that study showed. Reducing immigration will make the labor-starved field even less stable.

So what can be done?

Johnson points to a recent innovation by Washington state as one path forward.

Continued

Washington passed a law that imposes a 0.58% payroll tax on workers — a premium that pays into a fund to pay for home care, nursing home stay or family caregivers if they become disabled, Johnson said.

“We could think of some sort of public insurance like that as a way to deal with this problem,” he suggested.

Fishman said another option is to change Medicare and Medicaid to cover long-term care. Consideration of such a change probably should be pursued outside the larger health care reform discussion, he added.

Discussions of paying for long-term care have typically tied into other health care reform. “I wonder if that historically has been a mistake,” Fishman said.

The new study appears in the June issue of the journal Health Affairs.

WebMD News from HealthDay

Sources

SOURCES: Richard Johnson, Ph.D., senior fellow, Urban Institute, Income and Benefits Policy Center, Washington, D.C.; Eliot Fishman, Ph.D., senior director of health policy, Families USA; June 3, 2019,Health Affairs

Copyright © 2013-2018 HealthDay. All rights reserved.

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Obamacare May Have Helped Close ‘Race Gap’ in Cancer Care

MONDAY, June 3, 2019 — Expanding Medicaid coverage after the Affordable Care Act seems to have narrowed U.S. racial differences in cancer treatment, a new study suggests.

Before the Affordable Care Act, blacks diagnosed with advanced cancer were 4.8 percentage points less likely than whites to get treatment within the month after diagnosis, the researchers said.

States that expanded Medicaid in 2014, however, saw the number of black patients getting timely care increase from 43.5% to 49.6%. White patients saw a smaller increase, from 48.3% to 50.3%.

These numbers suggest that Medicaid expansion improved the quality of care, the researchers say.

“The post-expansion difference between the two groups’ access to timely care was no longer statistically significant,” Amy Davidoff, a senior research scientist at Yale School of Public Health, said in a university news release.

For the study, researchers used electronic health records from 2011 and 2019 to collect data on nearly 31,000 patients across 40 U.S. states.

The researchers defined timely treatment as starting chemotherapy, targeted therapy, hormone therapy or immunotherapy within 30 days of diagnosis.

Although the researchers took factors such as type of cancer, age, sex, region, cancer stage at diagnosis and unemployment rates, the study cannot prove that expanded Medicaid improved care, only that the two are associated.

The findings were presented Sunday at the American Society of Clinical Oncology annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.

More information

Visit the U.S. Centers for Medicare and Medicaid Services for more on the Medicaid expansion.

© 2019 HealthDay. All rights reserved.

Posted: June 2019

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For People With Heart Failure, Loneliness Can Mean Worse Care

TUESDAY, May 28, 2019 — Fewer than 1 in 10 heart failure patients follow lifestyle treatment recommendations, and a new study suggests that loneliness is a major reason why.

Polish researchers assessed 475 heart failure patients’ compliance with a regimen of restricting salt and fluid intake, being physically active, and weighing themselves each day.

Only 7 of the patients followed all four lifestyle recommendations. Nearly 48% got no exercise, and 19% rarely exercised. About 25% never and 17% rarely adhered to fluid restrictions, while 13% never and 22% rarely restricted salt intake. About 54% of patients weighed themselves less than once a week, and 17% did it once a week.

Salt and fluid restrictions help keep fluid retention under control, daily weighing alerts to worsening fluid retention, and exercise improves energy levels and quality of life, explained the authors of the stud.

Failure to follow lifestyle recommendations or regularly take medications contributes to worsening heart failure symptoms and an increased risk of hospitalization.

“Loneliness is the most important predictor of whether patients adopt the advice or not,” study senior author Beata Jankowska-Polaska, from Wroclaw Medical University, said in a news release from the European Society of Cardiology.

“Patients who are alone do worse in all areas. Family members have a central role in helping patients comply, particularly older patients, by providing emotional support, practical assistance, and advice,” she noted.

“We also found that women were less compliant than men, and patients over 65 had poorer scores than younger patients,” she added.

Loneliness, a higher number of other health problems, and heart failure that caused more physical limitations were independent predictors of not following the recommendations, the researchers said.

Doctors and nurses need to encourage better self-care in their patients with heart failure, according to Jankowska-Polaska.

“Patients need clear written instructions on how to exercise for example, while text messages or phone calls can be used as reminders. It’s important to check that patients understand the advice, tailor the recommendations, and assess adherence at every visit,” she said.

The research was presented Sunday at Heart Failure 2019, a meeting of the European Society of Cardiology, in Athens. Studies presented at scientific meetings should be considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart failure.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

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Do Doctors Give Better Care in the Morning?

By Amy Norton

HealthDay Reporter

FRIDAY, May 10, 2019 (HealthDay News) — Many people do their best work in the morning, and new research suggests the same may hold true for doctors.

The study, of nearly 53,000 primary care patients, found that doctors were more likely to order cancer screenings for patients seen early in the day, versus late afternoon.

During 8 a.m. appointments, doctors ordered breast cancer screenings for 64% of women who were eligible for them. That figure declined over the next few hours, rebounded around lunchtime, then fell again as the afternoon wore on: During 5 p.m. appointments, doctors ordered screening for just under 48% of eligible patients.

A similar pattern was seen with colon cancer screening. About 36% of patients with 8 a.m. appointments received a screening order, versus only 23% of those with 5 p.m. appointments.

What’s going on? Senior researcher Dr. Mitesh Patel speculated on one explanation: As the day goes on, doctors often fall behind schedule, and may run out of time for cancer screening discussions.

There’s “a lot to get done” during a standard appointment, Patel noted — from routine health checks, to flu shots, to whatever concerns the patient is bringing up.

“So the doctor might think, ‘I have limited time. I’ll talk about this [screening test] the next time,'” said Patel, an assistant professor of medicine at the University of Pennsylvania.

It’s also possible “decision fatigue” is a factor, he said.

If a doctor has spent much of the day talking to patients about cancer screening — and often hearing “no” — he or she might let it slide by day’s end.

“This is a reminder that doctors are human, too,” said Dr. Jeffrey Linder, a professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “They’re laboring under the same psychological and fatigue constraints as everyone else.”

Linder wrote an editorial accompanying the study, published May 10 in the journal JAMA Network Open.

“Not everyone can get an 8 a.m. appointment,” Linder pointed out. But, he said, it’s good for doctors and patients to be aware that time of day might affect their care.

Continued

The study is not the first to suggest doctors practice differently as the day wears on.

In an earlier study, Patel’s team found the pattern held true with flu shots: Patients seen late in the day were less likely to get them.

Other researchers have found that toward the end of the day, primary care doctors are more likely to inappropriately prescribe antibiotics or opioid painkillers.

It’s possible, Patel said, that patients are also in a rush toward day’s end, or dealing with their own decision fatigue.

“At the end of a workday,” he said, “you might not want to have a conversation about cancer screening.”

The findings are based on records from patients in the University of Pennsylvania health system who had primary care appointments between 2014 and 2016. Over 19,000 were eligible for breast cancer screening, while over 33,000 were eligible for colon cancer screening.

Patel and his team looked at whether patients received a screening order at their first appointment during the study period — and whether they actually went for screening over the next year.

They found that patients with late-day appointments were substantially less likely to be screened: One-third of women with an 8 a.m. appointment underwent breast cancer screening in the next year, versus 18% of those with 5 p.m. appointments. The figures for colon cancer screening were 28% and 18%, respectively.

What to do? Patel said there’s a “great opportunity” for technology to help. Patients’ electronic health records could be cued to remind doctors to order cancer screenings, for example.

Linder agreed. He also pointed to the low screening rates among these study patients overall. That, he said, suggests that patients need similar nudges, to encourage them to follow up on screening orders.

WebMD News from HealthDay

Sources

SOURCES: Mitesh Patel, M.D., assistant professor, medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia; Jeffrey Linder, M.D., M.P.H., professor, medicine, and chief, general internal medicine, Northwestern University Feinberg School of Medicine, Chicago; May 10, 2019,JAMA Network Open, online

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

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Why Do Older Heart Attack Patients Get Worse Care?

SATURDAY, April 6, 2019 — If you’re over 65 and have a heart attack, your care may be compromised, a new study finds.

In fact, you’re less apt than younger patients to receive a timely angioplasty to open blocked arteries. You’re also likely to have more complications and a greater risk of dying, researchers say.

“Seniors were less likely to undergo [angioplasty] for a heart attack and if they do receive the procedure it’s not within the optimal time for the best possible outcome,” said lead researcher Dr. Wojciech Rzechorzek, a resident at Mount Sinai St. Luke’s and Mount Sinai West Hospital in New York City.

“Their prognosis is worse than for younger patients with the same conditions, and this lack of treatment or delay in treatment could be a factor,” he noted.

But a New Jersey heart specialist said the delays in care are not neglect, but necessary.

“One of the most important things to keep in mind is that the older population is often sicker,” said Dr. Barry Cohen, who was not involved in the study. “Their conditions are often much more complicated, and for providers, that can mean treatment can’t be given right away.”

Older patients are more likely to have conditions such as kidney disease, as well as heart failure, diabetes or past heart problems. Before taking any patient for an angioplasty, it’s important to do a risk assessment, said Cohen, who is medical director of the cardiac catheterization lab at Atlantic Health System Morristown Medical Center.

“We’re not stalling, we’re strategically thinking about what is best for the patient, despite the desire to be under 90 minutes for door-to-angioplasty time,” he added.

For the study, Rzechorzek and colleagues reviewed 2014 data on more than 115,000 heart attack patients nationwide. Of those, 54 percent were over 65.

Their review found that seniors were 34 percent less likely than younger patients to have an angioplasty. In the procedure, special tubing is inserted into a narrowed or blocked artery, where a balloon is inflated to open the blockage. Sometimes, a stent is also placed to keep the vessel open.

The study found seniors were 36 percent less likely to receive a stent, and 34 percent less likely to have one placed within 48 hours.

Although both groups received the same drugs and surgical treatments, older patients had worse results, researchers said.

Compared to younger patients, older ones were 62 percent more likely to develop heart failure, and 28 percent more likely to go into shock.

They were also 21 percent more likely to have a cardiac arrest, and 10 percent more likely to need a ventilator to help them breathe, according to the study.

Though older patients stayed in the hospital longer, the cost of their care averaged about $ 3,231 less than that of younger patients. Researchers suspect that’s because many didn’t have angioplasty, a costly treatment.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said there is a real problem in how older heart attack patients are treated.

“While the investigators found that older patients had lower adjusted total hospital charges despite lower quality care and worse outcomes, this finding further illustrates how misleading and counterproductive it is for Medicare to be using cost data as a hospital level metric of quality and value,” said Fonarow, who was also not part of the study.

These findings highlight how important it is to improve the quality of care, particularly for older patients with heart attacks in U.S. hospitals, he said.

The study was scheduled to be presented Saturday at a meeting of the American Heart Association, in Arlington, Va. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

More information

The American Heart Association offers more information about heart attack.

© 2019 HealthDay. All rights reserved.

Posted: April 2019

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Spring Break Is No Vacation From Contact Lens Care

SATURDAY, March 30, 2019 — Spring break may mean sun and fun for lots of college kids, but it doesn’t mean they can forget about contact lens care, experts say.

Your risk of eye infections increases if you wear contacts and do things such as sleep in them, shower or swim with them in, and not wash your hands before handling them — all of which are more likely to happen when you’re busy enjoying your spring break.

The American Academy of Ophthalmology, American Academy of Optometry and the U.S. Centers for Disease Control and Prevention offer the following contact lens safety tips for travelers:

  • Pack a spare pair of glasses. Take out your contact lenses before jumping into the water at a beach or pool. Take your contact lenses out before bed, even if you’re up late.
  • Bring enough contact lens supplies with you on your trip. Don’t top off by adding new solution to old.
  • Never wear contact lenses that were not prescribed to you, especially decorative lenses sold at souvenir shops.
  • Always wash your hands with soap and water before touching your contact lenses.
  • Remove your contact lenses and call an eye doctor immediately if you experience redness, pain, tearing, discharge or swelling of your eyes, as well as increased light sensitivity or blurred vision.

“Most people don’t think of contact lenses as a medical device, but poor habits can set you up for serious eye infections that can damage vision or even cause blindness,” Dr. Tim Steinemann, clinical spokesperson for the American Academy of Ophthalmology, said in an academy news release.

About 40 million Americans use contact lenses. Each year, about one out of every 500 contact lens wearers develops serious eye infections that can lead to blindness because they fail to wear, clean, disinfect and store their contact lenses as directed, according to the CDC.

In addition, thousands more develop less serious infections or inflammation that can be painful and affect their daily routine, and even ruin their vacation.

More information

The U.S. Food and Drug Administration has more on contact lens care.

© 2019 HealthDay. All rights reserved.

Posted: March 2019

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More Teens, Kids Seeking Mental Health Care in ERs

By Alan Mozes
HealthDay Reporter

MONDAY, March 18, 2019 (HealthDay News) — U.S. emergency departments are seeing a surge in the number of kids and teens seeking help for mental health problems, new research warns.

Between 2011 and 2015 alone, there was a 28 percent jump in psychiatric visits among Americans between the ages of 6 and 24.

“The trends were not a surprise,” said study author Luther Kalb, given that “using the emergency department for mental health reasons has been increasing for a while” among all age groups.

But why is it happening among young people?

“The rising suicide and opioid epidemics are surely a factor,” given that “the ER plays a critical role in treating overdoses,” he said.

“Emergency Department providers could also be more likely to detect and/or ask about pediatric mental health issues, which leads to increased detection,” added Kalb, an assistant professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. “Parents may be more likely to report the child’s symptoms as well.

“There is also an increase in outpatient mental health service use overall among youth in the U.S.,” he noted. “This may lead to a trickle-down effect, where the provider sends the child to the [emergency department] during times of crisis.”

The omnipresence of social media may also play a notable role in upping youth depression risk, Kalb acknowledged, though he stressed that “it is unknown if social media plays a role increasing psychiatric ED use.”

The analysis revealed that while there had been about 31 psychiatric-related visits to the ER for every 1,000 Americans between the ages of 6 and 24 back in 2011, that figure had risen to more than 40 by 2015.

But that number shot up even higher among some groups.

For example, a roughly 54 percent increase was seen among adolescents as a whole, and black kids and young adults in particular. Among Hispanic youth, that figure rose to more than 90 percent.

What’s more, visits by adolescents of all backgrounds that were specifically related to suicide risk more than doubled during the study time frame.

Continued

The investigators also observed that even though many ER visits were long (with more than half lasting at least three hours), only about 16 percent of young patients were ever seen by a mental health professional during their visit. That figure did rise to 36 percent among those seeking care for suicide or self-harm.

“It’s important to note that almost all of these youth saw a physician,” said Kalb. “The problem is, not all ER physicians have mental health training.”

Still, he said he was “surprised at how few saw a mental health provider,” though he acknowledged that many rural and community hospitals simply lack the resources.

“This could be changed by increasing mental health staff in the ER, creating special intake settings that deal just with mental health, using new technologies such as tele-psychiatry, and cross-training providers,” Kalb noted.

The findings were published online March 18 in the journal Pediatrics.

Dr. Susan Duffy is a professor of emergency medicine and pediatrics at the Alpert Medical School of Brown University, and is an attending physician at Hasbro Children’s Hospital in Providence, R.I. She coauthored an editorial accompanying the study.

When discussing reasons behind the findings, Duffy painted a complicated picture that variously involves the roles of poverty; violence; child and parental substance abuse; expanded insurance coverage; the influence of social media on depression, isolation and anxiety risk; information overload; and a lack of mental health training and screening expertise among primary care physicians.

Still, regardless of which reasons apply most, the overall trends are clear, she said.

“Data suggests that over 20 percent of adolescents aged 13 to 18 have experienced a debilitating mental health disorder,” said Duffy. “For the past 10 years, there has been an increasing trend in children’s, youth and young adult mental health visits, and increasing recognition that the resources do not meet the need for care.”

So, the bottom line is that the findings “should not come as a great surprise,” she said.

WebMD News from HealthDay

Sources

SOURCES: Luther Kalb, Ph.D., assistant professor, Johns Hopkins Bloomberg School of Public Health, Baltimore; Susan Duffy, M.D., M.P.H., professor, emergency medicine and pediatrics, Alpert Medical School, Brown University, and attending physician, pediatric emergency medicine, Hasbro Children’s Hospital, Providence, R.I.; March 18, 2019, Pediatrics, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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Many Black Americans Live in Trauma Care ‘Deserts’

By Dennis Thompson

HealthDay Reporter

FRIDAY, March 8, 2019 (HealthDay News) — Black neighborhoods in America’s three largest cities are much more likely to be located in a “trauma desert,” an area without immediate access to a designated trauma center, a new study finds.

Census data for neighborhoods in New York City, Chicago and Los Angeles revealed that neighborhoods made up of mostly black residents are more often 5 miles or more away from a trauma center, compared with white or Hispanic neighborhoods, researchers said.

“We found that black neighborhoods were the only neighborhoods that were consistently in trauma deserts,” said lead researcher Dr. Elizabeth Tung, an internal medicine and primary care instructor with University of Chicago Medicine.

This means that medical care for stabbings, shootings and beatings is lacking in the urban areas most affected by violent crime, the researchers said.

Tung’s team noted that the rate of violent crime in rural Thurmont, Md., is five victims for every 10,000 people. The rate just 60 miles away, in urban Baltimore, is more than 25 times higher.

“When you think about who needs access to these services, it’s really the poor inner-city neighborhoods, and those are the neighborhoods least likely to have access,” Tung said.

Previous studies have associated urban trauma care deserts — or regions located more than 5 miles from a trauma center — with higher transport times and an increased risk of death, according to background notes in the study published online March 8 in JAMA Network Open.

For the new study, the investigators analyzed data from the 2015 American Community Survey, an annual research effort by the U.S. Census Bureau.

The researchers used the survey to assess the racial makeup of specific neighborhoods in the three largest U.S. cities. They found large proportions of majority-black neighborhoods in Chicago (35 percent) and New York City (21 percent), but not in Los Angeles (3 percent).

The investigators then compared the location of those neighborhoods to the sites of adult level I and level II trauma centers within the three cities.

Continued

The findings showed that black-majority neighborhoods were eight times more likely to be located in a trauma care desert in Chicago and five times more likely in Los Angeles. They also were nearly twice as likely in New York City to be in a trauma care desert, in models adjusting for poverty and race.

Interestingly, Hispanic-majority neighborhoods did not consistently have the same problem. They were actually less likely to be located in a trauma care desert in New York City and Los Angeles, and slightly more likely in Chicago, according to the report.

Many “safety net” trauma hospitals in poorer urban areas have shut down or scaled back operations over the years, as welfare and Medicaid funding have tightened, Tung said. This makes emergency care less available to people in those neighborhoods.

Examples include Michael Reese Hospital on the south side of Chicago, which closed in 1991 due to economic hardship, and Martin Luther King Jr. Hospital in Los Angeles, which lost its trauma center designation in 2004, the researchers noted.

On the other hand, activists in New York City rallied around Harlem Hospital and headed off its closure twice, which could explain why the Big Apple’s black communities are not as likely to be in a trauma care desert, Tung said.

It’s not cheap to operate a trauma center, said Dr. Lisa Marie Knowlton, an assistant professor of surgery at Stanford University Medical Center.

“The process of accreditation and maintenance of certification for level I trauma hospitals is a rigorous and costly process, and although many safety-net hospitals in urban settings provide level I care, they are already at financial risk,” said Knowlton, who wrote an editorial accompanying the new study.

“The tremendous cost to the hospital and system for providing care to vulnerable uninsured patients who lack adequate post-discharge resources places any hospital in these urban environments at risk,” Knowlton explained.

Physical proximity isn’t the only measure used to assess an area’s access to emergency care, said Dr. Rade Vukmir, a critical care specialist in Traverse City, Mich., who is also a fellow of the American College of Emergency Physicians.

Continued

“The question of how long does it take to get to emergency care is really the underpinning of what we do. In a rural environment, it’s a distance problem,” Vukmir said. “In a suburban and sometimes urban environment, it’s a congestion problem,” as ambulances battle traffic to deliver patients to a hospital.

Tung and Knowlton pointed out that providing better emergency care to neighborhoods in trauma care deserts will involve large-scale policy changes and programs.

“Additional state and federal funds should be allocated toward the provision of emergency services, including trauma care, regardless of patients’ ability to pay,” Knowlton said. “Further subsidization of safety-net hospitals providing critical services to high-risk patients in urban settings is warranted.”

Medicaid expansion could prove crucial in expanding funding to struggling urban hospitals, Knowlton added.

WebMD News from HealthDay

Sources

SOURCES: Elizabeth Tung, M.D., internal medicine and primary care instructor, University of Chicago Medicine; Lisa Marie Knowlton, M.D., M.P.H., assistant professor of surgery, Stanford University Medical Center, Stanford, Calif.; Rade Vukmir, M.D., critical care specialist, Traverse City, Mich., and fellow, American College of Emergency Physicians; March 8, 2019,JAMA Network Open,  online

Copyright © 2013-2018 HealthDay. All rights reserved.

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